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coverage varies by payer and LCD Post-bariatric surgery monitoring: gastric bypass and sleeve gastrectomy patients require routine B12 surveillance Strict vegetarian or vegan diet: dietary absence of B12 sources with symptomatic presentation Proton pump inhibitor (PPI) long-term use: chronic PPI therapy may impair B12 absorption Known B12 deficiency monitoring: follow-up testing during supplementation or injection therapy Anthem’s commercial policy CG-LAB-19 confirms metformin-related B12 depletion as a covered indication

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Therefore, a true overdose that causes toxicity is extremely rare